Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Interest of Proton Pump Inhibitors in Reducing the Occurrence of COVID-19: A Case-Control Study

Version 1 : Received: 28 April 2020 / Approved: 2 May 2020 / Online: 2 May 2020 (15:48:33 CEST)

How to cite: Blanc, F.; Waechter, C.; Vogel, T.; Schorr, B.; Demuynck, C.; Martin-Hunyadi, C.; Meyer, M.; Mutelica, D.; Bougaa, N.; Fafi-Kremer, S.; Calabrese, L.; Schmitt, E.; Imperiale, D.; Jehl, C.; Boussuge, A.; Suna, C.; Weill, F.; Matzinger, A.; Muller, C.; Karcher, P.; Kaltenbach, G.; Sauleau, E. Interest of Proton Pump Inhibitors in Reducing the Occurrence of COVID-19: A Case-Control Study. Preprints 2020, 2020050016 (doi: 10.20944/preprints202005.0016.v1). Blanc, F.; Waechter, C.; Vogel, T.; Schorr, B.; Demuynck, C.; Martin-Hunyadi, C.; Meyer, M.; Mutelica, D.; Bougaa, N.; Fafi-Kremer, S.; Calabrese, L.; Schmitt, E.; Imperiale, D.; Jehl, C.; Boussuge, A.; Suna, C.; Weill, F.; Matzinger, A.; Muller, C.; Karcher, P.; Kaltenbach, G.; Sauleau, E. Interest of Proton Pump Inhibitors in Reducing the Occurrence of COVID-19: A Case-Control Study. Preprints 2020, 2020050016 (doi: 10.20944/preprints202005.0016.v1).

Abstract

Background: COVID-19 is a disease of the elderly as 95% of deaths related to COVID-19 occur in people over 60 years of age. Despite the urgent need for a preventive treatment there are currently no serious leads, other than the vaccination. Objective: To find a preventive treatment of COVID-19 in elderly patients. Design: Retrospective case-control study. Setting: Robertsau Geriatric Hospital of the University Hospitals of Strasbourg, France. Patients: 179 elderly patients who had been in contact with the SARS-CoV-2, of whom 89 had tested RT-PCR-positive (COVID-pos) for the virus and 90 had tested RT-PCR-negative (COVID-neg). Measurements: Treatments within 15 days prior to RT-PCR (including antihypertensive drugs, antipsychotics, antibiotics, nonsteroidal anti-inflammatory drugs, proton pump inhibitors (PPIs), paracetamol, anticoagulant, oral antidiabetics (OADs), corticosteroids, immunosuppressants), comorbidities, symptoms, laboratory values, and clinical outcome were all collected using the electronic patient record. Results: COVID-pos patients more frequently had a history of diabetes (P=.016) and alcoholism (P=.023), a lower leukocyte count (P=.014) and a higher mortality rate– 29.2% versus 14.4% – (P=.014) when compared to COVID-neg patients. Patients on PPIs were 2.3 times less likely (odds ratio [OR] = 0.4381, 95% confidence interval [CI] [0.2331, 0.8175], P=.0053) to develop COVID-19 infection, compared to those not on PPIs. No other treatment decreased or increased this risk. COVID-19 patients on antipsychotics (P=.0013) and OADs (P=.0166) were less likely to die. Limitations: retrospective study. Conclusion: PPIs treatment lowered the risk of development of COVID-19 infection, and antipsychotics and OADs decreased the risk of mortality in geriatric patients. If further studies confirm this finding, PPIs could be used preventatively in the elderly in this pandemic context. Moreover, OADS and antipsychotics should be tested in clinical trials.

Subject Areas

COVID-19; elderly; proton pump inhibitors; antipsychotics; metformin; oral antidiabetics

Comments (1)

Comment 1
Received: 11 September 2020
Commenter: Bruno CHARPIAT
The commenter has declared there is no conflict of interests.
Comment: I invite authors to discuss recently published papers: Price E. Could the severity of COVID-19 be increased by low gastric acidity?. Crit Care. 2020;24(1):456. Published 2020 Jul 22. doi:10.1186/s13054-020-03182-0 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374651/ Almario CV, Chey WD, Spiegel BMR. Increased Risk of COVID-19 Among Users of Proton Pump Inhibitors [published online ahead of print, 2020 Aug 25]. Am J Gastroenterol. 2020;10.14309/ajg.0000000000000798. doi:10.14309/ajg.0000000000000798 Lee SW, Ha EK, Yeniova AÖ, et al. Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching [published online ahead of print, 2020 Jul 30]. Gut. 2020;gutjnl-2020-322248. doi:10.1136/gutjnl-2020-322248 https://gut.bmj.com/content/gutjnl/early/2020/07/30/gutjnl-2020-322248.full.pdf Luxenburger H, Sturm L, Biever P, et al. Treatment with proton pump inhibitors increases the risk of secondary infections and ARDS in hospitalized patients with COVID-19: coincidence or underestimated risk factor? [published online ahead of print, 2020 Jul 1]. J Intern Med. 2020;10.1111/joim.13121. doi:10.1111/joim.13121 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361636/ Charpiat B, Bleyzac N, Tod M. Proton Pump Inhibitors are Risk Factors for Viral Infections: Even for COVID-19? [published online ahead of print, 2020 Aug 10]. Clin Drug Investig. 2020;1-3. doi:10.1007/s40261-020-00963-x https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417108/
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